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Analysis

Covid-19 Continues Its Toll on Jails and Prisons

The former chief medical officer of NYC Correctional Health Services warns that the situation for people behind bars is deteriorating.

covid-prisons
Chris Carlson/AP

As of May 1, 14,513 incarcerated people and almost 4,000 workers in state and federal prisons have tested positive for Covid-19, according to data collected by the Marshall Project. Those figures are likely an undercount of the total number of infections because they only represent people who received a test. More than 200 incarcerated people have died.

In addition to prisons, jails are also hard hit by this virus. New York City’s jail system, for example, currently reports that 376 incarcerated people have Covid-19, but they are not releasing the cumulative number of people who have been infected. As a result, we don’t have a sense of the the total impact of this pandemic on those incarcerated in the city’s jails, a basic data problem that has been seen in other settings as well. Meanwhile, at Chicago’s Cook County Jail, nearly 500 detainees and more than 300 correctional officers have tested positive.

Many prisons across the country currently have far more occupants than they were designed to hold, which has led to dangerously close quarters where contagious diseases can spread even more rapidly. To discuss the ongoing public health crisis, I spoke with Dr. Homer Venters, a physician, epidemiologist, and the former chief medical officer of NYC Correctional Health Services, where he played a leadership role during the H1N1 outbreak in 2009.

I previously caught up with Dr. Venters in March to discuss how Covid-19 could threaten those who live in and work in correctional facilities across the country. At that time, there were no Covid-19 cases reported yet in U.S. jails and prisons. We spoke again this week as the numbers of incarcerated people and correctional staff who have contracted the virus continues to climb.

This conversation has been edited for length and clarity.

You have been monitoring conditions in correctional facilities over the last few weeks. What are you seeing and hearing both from incarcerated people and from correctional staff during this crisis?

There is an enormous disconnect between what’s being reported publicly and what people are actually experiencing in jails and prisons. None of that should surprise anybody who knows the criminal justice system.

The experience of correctional staff stands out to me. For example, three weeks ago, there was a shift toward providing correctional officers across the country with N95 masks. But I’ve talked to many officers, and almost none of them were trained or even told about what the masks are for, when they should be used, and what high-risk situations they are encountering. As a result, there are tens or even hundreds of thousands of discarded N95 masks. Other officers have masks but don’t wear them most of the time. Just that one picture shows how we can actually hurt our overall infection control efforts when we don’t really engage with the staff. I've seen this happen before in prior outbreaks. We sometimes have a tendency to copy and paste infection control ideas and policies from community settings and then plop them down in a correctional setting. It doesn't work and often makes things worse.

Similarly, some facilities will post signs about hand-washing for detained people but then continue to charge them for access to soap. That’s another example of how an infection control idea that was supposed to help slow the spread of Covid-19 behind bars actually made the situation worse, because it exacerbated the discrepancy between what people should do and what they actually can do.

Based on what you’re seeing, if someone in a correctional facility starts to feel ill, what are they being told to do? How do they see a doctor? Do they have to pay for that?

On paper, most facilities, whether a jail or a prison or ICE detention center, would say that they we have more than adequate systems established. But in my experience — based on conversations with Covid-19 patients, other patients, and health staff — these systems aren’t working. For example, most facilities have a broken request-for-care system. People may fill out repeated sick call requests, either via paper or computer, or both, and they may not be seen by a health professional. Or somebody may simply come to their cell and have the most limited amount of patient interaction possible without really figuring out whether the patient has symptoms consistent with Covid-19. The whole process could take days, and during that time, the patient may get sicker and may transmit the virus to people around them.

Covid-19 initially spread very quickly in urban areas but is now also affecting more rural areas. What worries you about the growing number of cases in correctional facilities in rural areas?

The spread of Covid-19 in correctional systems has had a profound impact on local hospitals. We have already seen several cases such as in Joliet, Illinois, where a single correctional facility can overwhelm the nearby hospital in just a couple of days. Sending even a single sick patient to the hospital is disruptive both for jail operations and for the hospital, because you're sending one person with two armed correctional officers. For most facilities, if you send in 15 patients a day, you completely deplete your correctional staff (who are often working overtime), and you essentially take over the hospital — certainly at least the emergency room. There are few hospitals in the country that can handle that many sick patients and the logistics involving armed guards.

Rural areas have seen a lot of hospital closings in the last 10 years. Because correctional settings like jails, prisons, and ICE detention centers are also concentrated in rural areas, Covid-19 creates the very real prospect that local hospitals will be quickly overwhelmed as the virus spreads rapidly throughout these facilities.

If incarcerated people are identified for early release, what happens to ensure that they are not positive for Covid-19 when they leave correctional facilities?

Coordinating a release can happen the right way in communities where there is already a good relationship between the local health department and the correctional facility. Questions to consider include: What's the safest place for the person to go? Do they need support? Many communities are, for example, reserving and buying or renting housing for people being released.

I want to guard against the notion that incarceration is better for people or for the community, because it's not. It's certainly better for everybody if we can promote earlier releases, which will help slow the spread of the virus inside facilities. But there isn’t really a scenario where it’s better to keep people incarcerated because they have Covid-19. As with any other communicable disease, there are important considerations for how to manage the reentry process. It's critical for community partners like the Department of Health to get involved in that process, because sheriffs and correctional officers do not currently have skills or resources to manage it.

The pandemic has now been unfolding for several weeks in the United States. What concerns you the most about its current trajectory, especially for incarcerated people?

Nationally, there’s an emerging narrative that we’re turning the corner on Covid-19. That could be true in certain ways. But this virus is really just now taking hold in correctional settings, and I think the worst is in front of us. There’s a great risk that what happens behind bars will be ignored. I also think we're going to lose a lot of correctional staff. I think a lot of staff will get sick — and some have already died — but we may have fewer people working in this space in the fall than we do now. If that happens, the conditions could be even worse. I worry that the public will move on and be eager to avoid thinking about anything related to Covid-19. Additionally, incarcerated people are already chronically ignored. I'm concerned that things could get much, much worse for them in the upcoming months.

I hope that the CDC and that state and local health departments get involved in addressing Covid-19 in our corrections systems. Both now and in the coming months, those entities will have a strong mandate — in large part an economic mandate — to do more coronavirus testing and contact tracing so that they can get people back to work, get kids back to school, and restore public confidence. All of that is important. But I fear that those same resources will be pulled even further away from efforts to detect and treat life-threatening illness behind bars. To me, it seems like things will get worse for incarcerated people even if the public narrative starts to go in the opposite direction.